Canadian patients' needs are increasingly complex. Health care should reflect that: CMA

More Canadians should receive their main health care through teams of professionals so their increasingly complex needs can be met while not paying privately for it, the Canadian Medical Association said in a new report released Tuesday.

The CMA's recommendations come after it undertook a major review of the interface of public and private care, as 6.5 million Canadians lack a family doctor, emergency departments burst at the seams and wait times for some surgeries mount.

Dr. Kathleen Ross, CMA president and a family physician in Coquitlam and New Westminster, B.C., called the primary care she offers the foundation and front door of Canada's health-care system. 

"We know something needs to change," Ross said. "It's not all about the medicines or pills that I prescribe." 

Ross gave her own clinic as an example of team-based care. She refers patients to counselling services and a dietitian, broadening the scope of meeting patients' increasingly complex needs. B.C. pays for six counselling sessions at her clinic, Ross said, while dietician referrals are hospital-based and funded only for certain conditions such as diabetes.  

Demand is high, Ross said, as people without a family doctor or nurse practitioner may rely on walk-in clinics and emergency departments that are already overcrowded, and don't provide comprehensive follow-up care. 

As wait times for diagnostic tests like MRIs and some surgeries grow, provinces from Ontario to P.E.I.  are expanding private surgical centres and virtual care to ease bottlenecks, while Quebec said it will limit the use of private nursing agencies. 

In its draft report, the CMA made 22 recommendations to guide policy on the mix of publicly and privately funded and delivered health care in Canada.

The group said its recommendations were based on a review of the literature and consultations with more than 10,000 physicians, patients and health-care providers who gave input through town halls and surveys. 

The CMA said a national consensus emerged that the health-care system should not favour those who can afford to pay for services. Instead, equity remained a bedrock value.  

Specifically, CMA set goals including:

Ross said there isn't much data supporting expanded access or improved quality of care in the private sector. The group is looking for up-to-date Canadian evidence. 

In Ontario, a family doctor provides a similar broad range of services under one roof as the province expands more publicly funded Family Health Teams and Community Health Centres. 

Dr. Danielle Martin, family doctor and chair of the family and community medicine department at the University of Toronto, welcomed the call to get every Canadian such access, saying training family physicians alone isn't enough to bridge the gap.